Omezaprole or not?

[Luac]

I was referred to a gastroenterologist because of some bowel issues. The GP thought they might be connected to malabsorption.

I had a colonoscopy and gastroscopy at the weekend. Colonoscopy seemed fine, biopsies were taken. Gastroscopy showed hiatus hernia, oesophagitis and gastritis. Biopsies were also taken. Im to wait three weeks for results and am also due urine/stool analysis results.

Ive been prescribed omezaprole for two months but that has counterindications with my HIV meds - rilpivirine which i take with abacavir. The hiv team have said they will change my meds to allow me to take omezaprole.

I have been self injecting 1mg hydroxocobalimin every two days or so for the past six weeks having just finished injections over three weeks at the gp. The hydroxocobalimin has had a huge and immediate difference - brain fog is almost entirely gone, low depressive mood has lifted, energy levels are much better and the daily pins and needles in both hands has gone. I have decided to self inject on my own as it is more convenient and easier to do so than through gp. The gp is unaware that I do this, but I will let them know. I intend to gradually wean myself down to less frequent doses. The difference in quality of life I get from the injections is huge.

I have also been recently prescribed 5mg ramipril for hypertension. I dont know whats causing that but I suspect it has been an issue for years and is not connected to lifestyle although i can always improve that.

My questions are:

- is the omezaprole good to take if i'm b12 deficient? Will it negate the hydroxocobalimin?

- is the omezaprole only to improve symptoms? I dont have heartburn unless i drink cheap wine or excessively drink alcohol, which I dobt do very frequently. It seems quite disruptive to take omezaprole and change my meds if its only for heartburn which i currently rarely get. About 8 years ago i had very frequent heartburn and had gaviscon on a near daily basis for a while. That is no longer the case. Will the omezaprole cure anything?

I'm trying to get to the bottom of the b12 deficiency and i think its connected to the bowel issues ive been having although the injections havent improved those. Im supposing they are a cause rather than a consequence.

Im having conversations between the GP, the endoscopy department and the hiv specialists (including pharmacist) so feel a bit disconnected.

Any thoughts?

[Thompson36]

Hi, I have similar issues with a hiatus hernia and recently polyps removed from bowel. I only take Omezaprole if I’m having symptoms of reflux which like you I only get on the odd occasion when I drink too much alcohol. I don’t know anything about HIV meds but would ask depending on your symptoms whether you could just take it when you need it or can you just get by with Gaviscon Advanced?

[Luac in reply to Thompson36]

Omezaprole cannot be taken at all with the rilpivirine I take as it depends on acids to work, but i can take Gaviscon allowing several hours before or after the rilpivirine. I would say that I might take gaviscon once a month for mild reflux.

[Thompson36 in reply to Luac]

Why have they said you need to be on Omezaprole? Just due to the hernia? I now know what foods also trigger mine so find that I don’t have many flare up’s and usually they are alcohol related. I can’t eat garlic, cheese or anything too rich like steak pie or gravy can set it off.

[Luac in reply to Thompson36]

I dont actually know why - the specialist asked me if I had heartburn when he was performing the gastroscopy and I said occasionally but I wasnt really in a clear state of mind. I didnt know about the prescribed omezaprole until afterwards.

[Thompson36 in reply to Luac]

I’d say if you or not currently having reflux issues then just keep it for if you have a flare but that’s me as I don’t like taking medication unless I have to and can usually get by with the Gaviscon Advanced. Good luck xx

[Luac in reply to Thompson36]

Thanks

[clivealive Forum Support]

The Omeprazole will have no effect on your B12 deficiency as long as you are receiving hydroxocobamalin injections.

I am not medically trained and wish you well

[Luac in reply to clivealive]

Thank you!

[fbirder]

The omeprazole will not be affected by, nor will it affect, your B12. Omeprazole (and other PPIs) can hinder the absorption of B12 from the gut. But your injections are bypassing that.

They should check for H. pylori infection as this could cause your symptoms and lower B12.

Did you get a written report of your gastroscopy results?

Was the gastritis all over the stomach or just on the corpus and fundus? If it's the latter then that's a good sign of autoimmune gastric atrophy.

If it is autoimmune gastritis then the biopsy sample might show signs of metaplasia (unexpected types of cells). That would mean Autoimmune Metaplastic Gastric Atrophy.

I'm working on an explanation of AMGA and B12. Here's part of my first draft...

AMGA is caused by the immune system killing off cells in the stomach called Gastric Parietal Cells (GPCs). This has three main effects -

GPCs produce something called Intrinsic Factor. IF is needed to carry the B12 molecule across the gut wall into the blood (it is too large to get across unaided). AMGA means no IF, which means no B12 is absorbed.

GPCs also produce hydrochloric acid. This is essential for many things. It activates an enzyme that digests proteins. It helps in the digestion of proteins itself. It stops bacteria from surviving in the stomach and invading the small intestine. Without stomach acid some food reaches the large intestine undigested and the bacteria that live there have a big party. This can produce gas, bloating and diarrhoea. (Sounds familiar?)

The symptoms of low stomach acid can be very similar to those of too much stomach acid. So it may be that the omeprazole isn't actually needed.

When you see the gastroenterologist ask if it might be autoimmune gastritis and if you may have low stomach acid, rather than high stomach acid. The Gastro may be interested in this article about achlorhydria - ncbi.nlm.nih.gov/books/NBK5...

[Luac in reply to fbirder]

Thank you for the detailed response. I was given a copy of the results of the procedures:

Result of urease test proved negative for helicobacter pylori

Lower Oesophagus - modified savary miller single or isolated erosion, oval or linear affecting one longitudinal fold, hiatus hernia sliding of length 3cm and oesophagitis/reflux

Stomach - non-erosive gastritis (mild erythemateous/exudative)

Duodenum - normal

[Luac in reply to Luac]

To be clear, it states gastritis was found in area between antrum and middle body.

[fbirder in reply to Luac]

Ah! The autoimmune gastritis that causes Pernicious Anaemia normally doesn't affect the antrum.

[Nackapan]

Dosent sound like you need the omezaprole. Seems drastic to have to change HIV Meds if you doing okay on them. Sounds good b12 injections helping you. I agree best to be transparent so on tour medical records.

[ollie7horse]

Hi Luac

I ha PA & thyroiditis I have been self injecting 2ml a week since 2013 also take vit d & folic acid and eat spinach for iron every day.

I recently had gastophy tube in stomach found gastritis, went on lansoprazole 30mg for 6 months had camera down it had gone.

I have stopped taking and realise gastritis will probably come back but eating well and will take 15 mg for a short period if I need to as I know the symptons.

Personally, I dont want to take them long term as all meds have side effects but they did work so I will only take low dose for about 3 months if I need to.

Obviously everyone is different but I'm sure you will find what suits you it takes long time but worth it.

Good luck

Ollie

[Sunshine1932]

I was on Omeprazole for a few years for the exact same reason and it did zero for me.

However once I found out I was B12 deficient I stopped taking them immediately and started self injections.

I have improved considerably however I do have lose bowls but nothing to be of concerns and I'm a vegan also so its expected from all my veg i guess.

I believe B12 deficiency and some unhealthy habits of alcohol and bulimia was the cause of my stomach issues.

Now I dont drink or purge, I self inject and my stomach is feeling wonderful.

Also I'm fully aware of what foods can cause me to be upset so i stay away from them. This tends to be wheat of too much sugar.

Be your own counsel and in my opinion they are not worth taking.

The body has a beautiful way of using it's own tools to heal itself.

Good luck

[jointpain]

Hi, was your ileum checked for flattening of the villi during the colonoscopy? Your symptoms are similar to my own a couple of years ago, I had debilitating gastric problems from what I now understand to be gluten intolerances and B12 deficiency. I SI B12 cobalamin every five days now and restrict the amount of gluten I have. Most of my neurological symptoms have gone as have my gastrointestinal issues. I hope this helps you.

[Missslk27]

Hiya I cant help you with this one sorry but I know My partner takes omeprazole for gastrisophocal problems and has been put on these after having an endoscopy and results ended him having to have these due to alot of acid problems ect x hope this helps x

[Miss-guineapig]

I think a standard dose of omeprazole definatly helps lots of people(20mg), and should be taken as prescribed. I had a lot of problems, too much to share here...but I took 80mg of omeprazole daily, for 7months, this damaged my partial cells in my stomach and that's the reason I ended up with PA. But this doseage is rare and please don't be put off by what happened to me. However all your meds have to work together so you need a good chat with your GP. I wish you well xx

[Luac]

Ive been further instructed that the omezaprole will heal oesphagitis and gastritis regardless of acid symptoms.

My hiv meds have been changed accordingly and I will pick up the omezaprole tomorrow.

Thank goodness for the NHS! All has been done quickly and with a smile!

Thanks for the advice 😊

[Zebra20]

I have PA and a 6 cm hiatal hernia and erosive esophagitis and Barrett’s.

Barrett’s is a precancerous condition in the esophagus- most of the time it stays precancerous, but it needs to be monitored every 3 years or so by endoscopy to make sure it hasn’t progressed. When I stopped omeprazole I ended up with 2 deep esophageal ulcers. Many medications later my esophagus is fine, but I will be taking PPIs (omeprazole is a PPI -proton pump inhibitor) for the rest of my life.

As far as I know the B 12 has nothing to do with the GERD. My B12 at its lowest was 115. My GI doc said omeprazole can lower B12 absorption but not to as low as 115. She said my lack of intrinsic factor was more likely the cause of the low B12. Btw, I’ve read a lot and have never read that proton pump inhibitors damage parietal cells. Blocking acidification of the stomach can decrease absorption but it doesn’t damage parietal cells and thus IF.